Preoperative assessment of the neurovascular complex at each level to be treated on axial MRI leave a message is essential to have a preoperative understanding of regional anatomy as it relates to the lateral approach [25]. In the first 30 cases of XLIF at one institution, the authors observed a 13% complication rate in 30 patients with two reoperations occurring. Mean followup was 11.5 months and low back and leg pain decreased by 63% and 56%, respectively, with similar improvements in disability (41.2%) and physical and mental quality of life (51.3% & 8.1%, resp.). In comparison with alternative approaches for lumbar interbody fusion, complications rates with transforaminal and posterior lumbar interbody fusion (T/PLIF) have generally been reported in elevated ranges compared to the current series.

In 2009, Rihn et al. [9] reported on a series of 119 TLIF cases performed at Thomas Jefferson University Hospital. An overall complication rate of 46% (55) was observed in 35% (40) of patients. While 10 complications were attributed to iliac crest bone graft harvesting, there was a 10.9% rate of new postoperative radiculitis, a 5% infection rate, and a 10.1% reoperation rate. Similarly, Okuda et al. [26] in 2006 reported the surgical complications of 251 PLIF patients treated at a single institution. In this series, the authors found an intraoperative complication rate of 10.3% with a new postoperative neurologic deficit rate of 8.3% (21; 19 motor, 2 sensory), with 32% of those classified as slight, 47% severe, and 21% permanent.

Results in the current series, having observed a 13% complication rate, is favorable to these similar study-design historical results, even when factoring in that cases in the current series represented the adoption of a new procedure [11, 12]. In total, six (20%) neural adverse events occurred, one motor complication and 5 sensory side-effects, rates which are consistent with high-quality prospective multicenter studies of XLIF performed using surgeons already familiar with the procedure [14]. Tohmeh et al. [14] observed a 17.5% rate of transient anterior thigh sensory changes postoperatively with Cilengitide a 2.9% new motor deficit rate in 102 XLIF patients treated at L3-4 and/or L4-5. In addition, the single incidence of motor injury occurred as a result of a misplaced cage (case 6) rather than during direct injury by procedural instrumentation during the approach for procedure.